>> Welcome to this IBM Watson Health client conversation. And we're probing the dynamics of the relationship between IBM and it's clients. We're going to look back at some of the challenges of 2020 and look forward to, you know, present year's priorities. We'll also touch on the future state of healthcare. My name is Dave Vellante. I'll be your host and I'm from theCUBE. And with me are Doctor Alex Towbin, who's Associate Chief Clinical Operations and Informatics at Cincinnati ChilDoctoren's Hospital and John Chrisman of course from IBM Watson health. Welcome gentlemen, Good to see you. Thanks for coming on. >> Thanks for having us. >> Yeah, thanks for having me. >> Yeah I know from talking to many clients around the world, of course virtually this past year, 11 months or so that relationships with technology partners they've been critical over during the pandemic to really help folks get through that. Not that we're through it yet but, we're still through the year now, there's I'm talking professionally and personally and Doctor Towbin, I wonder if you could please talk about 2020 and what role the IBM partnership played in helping Cincinnati children's, you know press on in the face of incredible challenges? >> Yeah, I think our story of 2020 really starts before the pandemic and we were fortunate to be able to plan a disaster and do disaster drill scenarios. And so, as we were going through those disaster drill scenarios, we were trying to build a solution that would enable us to be able to work if all of our systems were down and we worked with IBM Watson Health to design that solution to implement it, it involves using other solutions from our primary one. And we performed that disaster drill in the late January, early February timeframe of 2020. And while that drill had nothing to do with COVID it got us thinking about how to deal with a disaster, how to prepare for a disaster. And so we've just completed that and COVID was coming on the horizon. I'm starting to hear about it coming into the U.S for the first time. And we took that very seriously on our department. And so, because we had prepared for this this disaster drill had gone through the entire exercise and we built out different scenarios for what could happen with COVID what would be our worst case scenarios and how we would deal with them. And so we were able to then bring that to quickly down to two options on how our department and our hospital would handle COVID and deal with that within the radiology department and like many other sites that becomes options of working from home or working in a isolated way and an and an office scenario like where I'm sitting now and we planned out both scenarios and eventually made the decision. Our decision at that point was to work in our offices. We're fortunate to have private offices where we can retreat to and something like that. And so then our relationship with IBM was helpful and that we needed to secure more pieces of hardware. And so even though IBM is our PACS vendor and our enterprise imaging vendor, they also help us to secure the high resolution monitors that are needed. And we needed a large influx of those during the pandemic and IBM was able to help us to get those. >> Wow! So yeah you were able to sort of test your organization resilience before the pandemic. I mean, John, that's quite an accomplishment for last year. I'm sure there are many others. I wonder if one of you could pick it up from here and bring your perspectives into it and, you know maybe ask any questions that you would like to ask them. >> Yeah, sure, Doctor Towbin, that's great that we were able to help you with the hardware and procure things. So I'm just curious before the pandemic how many of the radiologists ever got to read from home, was that a luxury back then? And then post pandemic, are you guys going to shift to how many are on-site versus remote? >> Yeah, so we have a couple of scenarios. We've had talk about it both from our PACS perspective as well as from our VNA enterprise imaging perspective from PACS perspective we always designed our solution to be able to work from a home machine. Our machines, people would access that through a hospital-based VPN. So they would log in directly to VPN and then access the PACS that way. And that worked well. And many of our radiologists do that particularly when they're on call works best for our neuroradiologist who are on call a little bit more frequently. And so they do read from home in that scenario. With enterprise imaging and are used to the enterprise viewer and iConnect access. We always wanted that solution to work over the internet. And so it's set up securely through the internet but not through the VPN. And we have radiologists use that as a way to view studies from home, even not from home, so it can be over one of their mobile devices, such as an iPad and could be at least reviewing studies then. We, for the most part for our radiologist in the hospital that's why we made the decision to stay in the hospital. At COVID time, we have such a strong teaching mission in our department in such a commitment to the education of our trainees. We think that hospital being in the hospital is our best way to do that, it's so hard. We find to do it over something like zoom or other sharing screen-sharing technology. So we've stayed in and I think we'll continue to stay in. There will be some of those needs from a call perspective for example, reading from home, and that will continue. >> And then what's your success been with this with the technology and the efficiency of reading from home? Do you feel like you're just as efficient when you're at home versus onsite? >> The technology is okay. The, our challenges when we're reading from the PACS which is the preferred way to do it rather than the enterprise archive, the challenge is we have to use the PACS So we have to be connected through VPN which limits our bandwidth and that makes it a little bit slower to read. And also the dictation software is a little bit slower when we're doing it. So moving study to study that rapid turnover doesn't happen but we have other ways to make, to accelerate the workflow. We cashed studies through the worklist. So they're on the machine, they load a little bit more rapidly and that works pretty well. So not quite as fast, but not terrible. >> We appreciate your partnership. I know it's been going on 10 years. I think you guys have a policy that you have to look at the market again every 10 years. So what do you think of how the market's changed and how we've evolved with the VNA and with the zero footprint viewers? A lot of that wasn't available when you initially signed up with Amicas years ago, so. >> Yeah, we signed up so we've been on this platform and then, you know now the IBM family starting in 2010, so it's now now 11 years that we're, we've been on as this version of the PACS and about eight, seven or eight years from the iConnect platform. And through that, we've seen quite an evolution. We were one of the first Amicas clients to be on version six and one of the largest enterprises. And that went from, we had trouble at the launch of that product. We've worked very closely with Amicas then to merge. And now IBM from the development side, as well as the support side to have really what we think is a great product that works very well for us and drives our entire workflow all the operations of our department. And so we've really relished that relationship with now IBM. And it's been a very good one, and it's allowed us to do the things like having disaster drill planning that we talked about earlier as far as where I see the market I think PACS in particular is on the verge of the 3.0 version as a marketplace. So PACSS 1 one was about building the packs, I think, and and having electronic imaging digital imaging, PACS 2.0 is more of web-based technology, getting it out of those private networks within a radiology department. And so giving a little bit more to the masses and 3.0 is going to be more about incorporating machine learning. I really see that as the way the market's going to go and to where I think we're at the infancy of that part of the market now about how do you bring books in for machine learning algorithms to help to drive workflow or to drive some image interpretation or analysis, as far as enterprise imaging, we're on the cusp of a lot there as well. So we've been really driving deep with enterprise imaging leading nationally enterprise imaging and I have a role in the MSAM Enterprise Imaging Community. And through all of that work we've been trying to tackle works well from enterprise imaging point of view the challenges are outside of radiology, outside of cardiology and the places where we're trying to deal with medical photos, the photographs taken with a smart device or a digital camera of another type, and trying to have workflow that makes sense for providers not in those specialty to that don't have tools like a DICOM modality workloads store these giant million-dollar MRI scanners that do all the work for you, but dealing with off the shelf, consumer electronics. So making sure the workflow works for them, trying to tie reports in trying to standardize the language around it, so how do we tag photos correctly so that we can identify relevancy all of those things we're working through and are not yet standard within our, within the industry. And so we're doing a lot there and trying and seeing the products in the marketplace continuing to evolve around that on the viewer side, there's really been a big emergence as you mentioned about the zero footprint viewers or the enterprise viewer, allowing easy access easy viewing of images throughout the enterprise of all types of imaging through obtained in the enterprise and will eventually incorporate video pathology. The market is also trying to figure out if there can be one type of viewer that does them all that and so that type of universal viewer, a viewer that cardiologists can use the same as a radiologist the same as a dermatologist, same as a pathologist we're all I think a long way away from that. But that's the Marcus trying to figure those two things out. >> Yeah, I agree with you. I agree with your assessment. You talked about the non DICOM areas, and I know you've you've partnered with us, with ImageMover and you've got some mobile device capture taking place. And you're looking to expand that more to the enterprise. Are you also starting to use the XDS registry? That's part of the iConnect enterprise archive, or as well as wrapping things in DICOM, or are you going to stick with just wrapping things in DICOM? >> Yeah, so far we've been very bunched pro DICOM and using that throughout the enterprise. And we've always thought, or maybe we've evolved to think that there is going to be a role for XDS are I think our early concerns with XDS are the lack of other institutions using it. And so, even though it's designed for portability if no one else reads it, it's not portable. If no one else is using that. But as we move more and more into other specialties things like dermatology, ophthalmology, some of the labeling that's needed in those images and the uses, the secondary uses of those images for education, for publication, for dermatology workflow or ophthalmology workflow, needs to get back to that native file and the DICOM wrap may not make sense for them. And so we've been actively talking about switching towards XDS for some of the non DICOM, such as dermatology. We've not yet done that though. >> Given the era children's hospital has the impact on your patient load, then similar to what regular adult hospitals are, or have you guys had a pretty steady number of studies over the last year? >> In relay through the pandemic, we've had, it has been decreased, but children fortunately have not been as severely affected as adults. There is definitely disease in children and we see a fair amount of that. There are some unique things that happen in kids but that fortunately rare. So there's this severe inflammatory response that kids can get and can cause them to get very sick but it is quite rare. Our volumes are, I think I'm not I think our volumes are stable and our advanced imaging things like CT, MRI, nuclear medicine, they're really most decreased in radiography. And we see some weird patterns, inpatient volumes are relatively stable. So our single view chest x-rays, for example, have been stable. ER, visits are way down because people are either wearing masks, isolating or not wanting to come to the ER. So they're not getting sick with things like the flu or or even common colds or pneumonias. And so they're not coming into the ER as much. So our two view x-rays have dropped by like 30%. And so we were looking at this just yesterday. If you follow the graphs for the two we saw a dip of both around March, but essentially the one view chest were a straight line and the two view chest were a straight line and in March dropped 30 to 50% and then stayed at that lower level. Other x-rays are on the, stay at that low level side. >> Thanks, I know in 2021 we've got a big upgrade coming with you guys soon and you're going to stay in our standalone mode. I understand what the PACSS and not integrate deeply to the VNA. And so you'll have a couple more layers of storage there but can you talk about your excitement about going to 8.1 and what you're looking forward to based on your testimony. >> Yeah we're actually in, we're upgrading as we're talking which is interesting, but it's a good time for talking. I'm not doing that part of the work. And so our testing has worked well. I think we're, we are excited. We, you know, we've been on the product as I mentioned for over 10 years now. And for many of those years we were among the first, at each version. Now we're way behind. And we want to get back up to the latest and greatest and we want to stay cutting edge. There've been a lot of reasons why we haven't moved up to that level, but we do. We're very careful in our testing and we needed a version that would work for us. And there were things about previous versions that just didn't and as you mentioned, we're staying in that standalone mode. We very much want to be on the integrated mode in our future because enterprise imaging is so important and understanding how the comparisons fit in with the comparison in dermatology or chest wall deformity clinic, or other areas how those fit into the radiology story is important and it helped me as a radiologist be a better radiologist to see all those other pictures. So I want them there but we have to have the workflow, right. And so that's the part that we're still working towards and making sure that that fits so we will get there. It'll probably be in the next year or two to get to that immigrating mode. >> As you, look at the number of vendors you have I think you guys prefer to have less vendor partners than than more I know in the cardiology area you guys do some cardiology work. What has been the history or any, any look to the future of that related to enterprise imaging? Do you look to incorporate more of that into a singular solution? >> Cardiology is entirely part of our enterprise imaging solution. We all the cardiology amendments go to our vendor neutral archive on the iConnect platform. All of them are viewed across the enterprise using our enterprise viewer. They have their unique specialty viewer which is, you know, fine. I'm a believer that specialty, different specialties, deserve to have their specialty viewers to do theirs specialty reads. And at this point I don't think the universal viewer works or makes sense until we have that. And so all the cardiology images are there. They're all of our historical cardiology images are migrated and part of our enterprise solution. So they're part of the entire reference the challenge is they're just not all in PACSS. And so that's where, you know, an example, great example, why we need to get to this to the integrated mode to be able to see those. And the reason we didn't do that is the cardiology archive is so large to add a storage to the PACS archive. Didn't make sense if we knew we were going to be in an integrated mode eventually, and we didn't want to double our PACS storage and then get rid of it a couple of years later. >> So once you're on a new version of merge PACS and you're beyond this, what are your other goals in 2021? Are you looking to bring AI in? Are you using anybody else's AI currently? >> Yeah, we do have AI clinical it's phone age, so it's not not a ton of things but we've been using it clinically, fully integrated, it launches. When I open a study, when I opened a bone age study impacts it launches we have a bone age calculator as well that we've been using for almost two decades now. And so that we have to use that still but launching that automatically includes the patient's sex and birth date, which are keys for determining bone age, and all that information is there automatically. But at the same time, the images are sent to the machine learning algorithm. And in the background the machine determines a bone age that in the background it sends it straight to our dictation system and it's there when we opened the study. And so if I agree with that I signed the report and we're done. If I disagree, I copy it from my calculator and put it in until it takes just a couple of clicks. We are working on expanding. We've done a lot of research in artificial intelligence and the department. And so we've been things are sort of in the middle of translation of moving it from the research pure research realm to the clinical realm, something we're actively working on trying to get them in. Others are a little bit more difficult. >> That's the question on that John, Doctor, when you talk about injecting, you know machine intelligence into the equation. >> Yeah. >> What, how do you sort of value that? Does that give you automation? Does it improve your quality? Does it speed the outcome and maybe it's all of those but how do you sort of evaluate the impact to your organisation? >> I there's a lot of ways you can do it. And you touched on one of my favorite one of my favorite talking points, in a lot of what we've been doing and early machine learning is around image interpretation helping me as a radiologist to see a finding. Unfortunately, most of the things are fairly simple tasks that it's asking us to do. Like, is there a broken bone? Yes or no, I'm not trying to sound self-congratulatory or anything, but I'm really good at finding broken bones. I get, I've been doing it for a long time and, and radio, you know so machines doing that, they're going to perform as well as I can perform, you know, and that's the goal. Maybe they'll perform a little bit better maybe a little bit worse but we're talking tiny increments there they're really to me, not much value of that it's not something I would want. I don't value that at a time where I think machine learning can have real value around more on some of the things that you mentioned. So can it make me more efficient? Can it do the things that are so annoying that and they'd take, they're so tedious that they make me unhappy. A lot of little measurements for example are like that an example. So in a patient with cancer, we measure a little tumors everywhere and that's really important for their care, but it's tedious and so if a machine could do that in an automated way and I checked it that, you know, patient when because he or she can get that good quality care and I have a, you know, a workflow efficiency game. So that one's important. Another one that would be important is if the machine can see things I can't see. So I'm really good at finding fractures. I'm not really good at understanding what all the pixels mean and, you know in that same patient with cancer, oh what do all the pixels mean in that tumor? I know it's a tumor. I can see the tumor, I can say it's a tumor but sometimes those pixels have a lot of information in them and may give us prognosis, you know, say that this patient may, maybe this patient will do well with this specific type of chemotherapy or a specific or has a better prognosis with one with one drug compared to another. Those are things that we can't usually pick out. You know, it's beyond the level of that are I can perceive that one is really the cutting edge of machine learning. We're not there yet and then the other thing are things that, you know just the behind the scenes stuff that I don't necessarily need to be doing, or, you know so it's the non interpretive artificial intelligence. >> Dave: Right. >> And that's what I've been also trying to push. So an example of when the algorithms that we've been developing here we check airways. And this is a little bit historical in our department, but we want to make sure we're not missing a severe airway infection. That can be deadly, it's incredibly rare. Vaccines have made it go away completely but we still check airways. And so what happens is the technologist takes the x-ray. They come in to ask us if it's okay, we are interrupted from what we're doing. We open up the study, say yes or no. Okay, not okay, if it's not okay they go back, take another study. Then come back to us again and say, is it okay or not? And we repeat this a couple of times it takes them time that they don't need to spend and takes us time. And so we have, we've built an algorithm where the machine can check that and their machine is as good or a little bit worse than us, but give can give that feedback. >> Dave: Got it. >> The challenge is getting that feedback to the technologist quickly. And so that's, that's I think part for us to work on stuff. >> Thank you for that. So, John, we've probably got three or four minutes left. I'll let you bring it home and appreciate that Doctor Towbin >> I think one of the biggest impacts probably I knew this last year with the pandemic, Doctor Towbin is this, I know you're a big foodie. So having been to some good restaurants and dinners with the hot nurse in a house how's the pandemic affected you personally. And some of the things you like to do outside of work. >> Everything is shut down. And everything has changed. I have not left the house since March besides come to work and my family hasn't either. And so we're hardcore quarantining and staying you know, staying out and keeping it home. So we've not gone out to dinner or done much else. >> So its DoorDash and Uber Eats or just learned to cook at home. >> It's all cooking at home. We're fortunate, my wife loves to cook. My kids love to cook. I enjoy cooking, but I don't have the time as often. So we've done a lot of different are on our own experimenting. Maybe when the silver lining one of the things I've really relished about all this is all this time I get to spend with my family. And that closeness that we've been able to achieve because of being confined in our house the whole time. And so I've played get to play video games with my kids every night. We'd been on a big Fortnite Keck lately since it's been down making. So we've been playing that every night since we've watched movies a lot. And so as a family, we've, I it's something I'll look back fondly even though it's been a very difficult time but it's been an enjoyable time. >> I agree, I've enjoyed more family time this year as well, but final question is in 2021, beyond the PACS upgrade what are the top other two projects that you want to accomplish with us this year? And how can we help you? >> I think our big one is are the big projects are unexpanded enterprise imaging. And so we want to continue rolling out to other areas that will include eventually incorporating scopes, all the images from the operating room. We need to be able to get into pathology. I think the pathology is really going to be a long game. Unfortunately, I've been saying that already for 10 years and it's still probably another 10 years ago but we need to go. We can start with the gross pathology images all the pictures that we take for tumor boards and get those in before we start talking about whole slide scanning and getting in more of the more of the photographs in the institution. So we have a route ambulatory but we need inpatient and ER. >> All right one last question. What can IBM do to be a better partner for you guys? >> I think it's keep listening keep listening and keep innovating. And don't be afraid to be that innovative partner sort of thinking as the small company that startup, rather than the giant bohemoth that can sometimes happen with large companies, it's harder. It is fear to turn quickly, but being a nimble company and making quick decisions, quick innovations. >> Great, quick question. How would you grade IBM, your a tough grader? >> It depends on what I am a tough grader but it depends on what, you know as the overall corporate partnership? >> Yeah the relationship. >> I'd say it's A minus. >> Its pretty good. >> I think, I mean, I, we get a lot of love from IBM. I'm talking specifically in the imaging space. I not, maybe not, I don't know as much on the hardware side but we, yeah, we have a really good relationship. We feel like we're listened to and we're valued. >> All right, well guys, thanks so much. >> So even if it's not an A plus- >> Go ahead. >> I think there's some more to, you know, from the to keep innovating side there's little things that we just let you know we've been asking for that we don't always get but understand the company has to make business decisions not decisions on what's best for me. >> Of course got to hold that carrot out too. Well thanks guys, really appreciate your time. Great conversation. >> Yeah, thank you. >> All right and thank you for spending some time with us. You're watching client conversations with IBM Watson Health.

>> Welcome to this IBM Watson Health "Client Conversation." We're probing the dynamics of the relationships between IBM and its clients. And we're going to look back, we're going to explore the present situation and we're going to discuss the future state of healthcare. My name is Dave Vellante from theCUBE and with me are Dr. David Huelsman, who is a radiologist at TriHealth, which is a provider of healthcare in hospitals and John Kritzman who is with of course IBM Watson Health. Gentlemen welcome. Thanks so much for coming on. >> Thank you. >> Yeah, thanks for having us. >> Doctor let me say you're welcome. Let me start with you. As an analyst and a TV host in the tech industry, we often focus so much on the shiny new toy, the new widget, the new software. But when I talk to practitioners, almost to a person, they tell me that the relationship and trust are probably the most important elements of their success, in terms of a vendor relationship. And over the last year, we've relied on both personal and professional relationships to get us through some of the most challenging times any of us have ever seen. So, Dr. Huelsman, let me ask you, and thinking about the challenges you faced in 2020, what does partnership mean to you and how would you describe the relationship with IBM? >> Well, it is exactly the reason why when we started our journey on this enterprise imaging project at TriHealth, that we very early on made the decision We only wanted one vendor. We didn't want to do it piecemeal, like say get a vendor neutral archive from one organization, and the radiology viewer from another. We wanted to partner with the chosen vendor and develop that long-term relationship, where we learn from each other and we mutually benefit each other, in sort of not just have a transactional relationship, but that we share the same values. We share the same vision. And that's what stood out to us is Watson Health imagings vision, mirrored TriHealth's in what we were trying to achieve with our enterprise imaging project. >> You know, let me follow up with that if I could. A lot of times you hear the phrase, "Single throat to choke" and it's kind of a pejorative, right? It's a really negative term. And the way you just described that Dr. Huelsman is you were looking for a partnership. Yeah, sure. Maybe it was more manageable and maybe it was a sort of Singletree, but it was really about the partnership, going forward in a shared vision and really shared ownership of the outcome. Is that a fair characterization? >> Yeah, how about more positive is "One hand to shake." >> Wow, yeah, I love it. (chuckles) One hand to shake. I'm going to steal that line. That's good. I like it. Keep it positive. Okay, John, when you think about the past 12 months and I know you have history with TriHealth, and more recently have rejoined the account, but how would you kind of characterize that relationship and particularly anything you can add about the challenges of the 2020? What stands out to you? >> Yeah, I think going back to your one hand to shake or one vendor to hug all that's not allowed during COVID, but we're excited to be back working with you, I am in particular. And at the beginning of this sales process and RFP when you guys were looking for that vendor partner, we did talk to you about the journey, the journey with AI that we already had mature products on the vendor neutral archive side and all the product pieces that you were looking for. And I know you've recently went live over the last year and you've been working through, crawling through and learning to walk and starting to run, hopefully. And at some point we'll get to the end of the marathon, where you'll have all the AI pieces that you're looking for. But this journey has been eyeopening for all of us, from using consultants in the beginning, to developing different team members to help make you successful. So I think I've been tracking this from the outside looking in, and I'm happy to be back, more working direct with you this year to help ensure your longterm success. >> Yeah, that's great John. You have some history there. I'm going to probe that a little bit. So doctor, you talked about this enterprise imaging project. I presume that's part of, that's one of the vectors of this journey that you're on. What are you trying to accomplish in the sort of near term and midterm in 2021? John mentioned AI, is there a data element to this? Are there other, maybe more important pressing things? What are your main goals for 2021? >> Sure. Well, where we are, where we've started, the first step was getting all of our imaging stored consistently in the same place and in the same way. We had like many health system, as you grow, you acquire facilities, you acquire physician practices and they all have their own small packs system, different ways of storing the data. And so it becomes very unwieldy to be a large organization and try to provide a consistent manner of your physicians interacting with the data, with the imaging in the same way. And so it was a very large dissatisfier in our EMR to, oh if you wanted to see cardiovascular imaging, it's this tab. If you wanted to see radiology, it was this tab. If you wanted to see that, oh you got to go to the media tab. And so our big goal is, okay, let's get the enterprise archive. And so the Watson enterprise archive is to get all of our imaging stored in the same place, in the same way. And so that then our referring physicians and now with our patients as well, that you can view all the imaging, access it the same way and have the same tools. And so that's the initial step. And we're not even complete with that first step, that's where COVID and sort of diverting resources, but it's there, it's that foundation, it's there. And so currently we have the radiology, cardiology, orthopedics and just recently OB-GYN, all of those departments have their images stored on our Watson Enterprise Archive. So the ultimate goal was then any imaging, including not just what you typically think of radiology, but endoscopy and arthroscopy and those sort of images, or wound care images, in that any image, any picture in our organization will be stored on the archive. So that then when we have everything on that archive, it's easier to access consistently with the same tools. But it's also one of the large pieces of partnering with with Watson Health Imaging, is the whole cognitive solutions and AI piece. Is that, well now we're storing all the data in a consistent manner, you can access it in a consistent manner, well then we hope to analyze it in a consistent manner and to use machine learning, and the various protocols and algorithms that Watson Health Imaging develops, to employ those and to provide better care. >> Excellent, thank you for that. John, I wonder if you could add to that? I mean, you've probably heard this story before from other clients, as well as TriHealth, I call it EMR chaos. What can you add to this conversation? I'm particularly interested in what IBM Watson Health brings to the table. >> Sure, we've continued to work with TriHealth. And like we said earlier, you do have to walk before you can run. So a lot of this solution being put in place, was getting that archive stood up and getting all the images transferred out of the legacy systems. And I think that we're nearly done with that process. Doing some find audits, able to turn off some of the legacy systems. So the data is there for the easier to do modalities first, the radiology, the cardiology, the OB, as Dr. Huelsman mentioned and the ortho. And now it's really getting to the exciting point of really optimizing everything and then starting to bring in other ologies from the health system, trying to get everything in that single EMR view. So there was a lot of activity going on last year with optimizing the system, trying to fine tune hanging protocols, make the workflow for everybody, so that the systems are efficient. And I think we will continue on that road this year. We'll continue down further with other pieces of the solution that were not implemented yet. So there's some deeper image sharing pieces that are available. There are some pieces with mobile device image capture and video capture that can be deployed. So we look forward to working in 2021 on some of those areas, as well as the increased AI solutions. >> So Dr. Huelsman I wonder if you could double click on that. I mean if you're talking to IBM, what are the priorities that you have? What do you, what do you really need from Watson Health to get there? >> So I spoke with Daniel early last week, and sort of described it as now we have the foundation, we sort of have the skeleton and now it's time to put meat on the bones. And so what we're excited about is the upcoming patient synopsis would be the first piece of AI cognitive solutions that Watson Health Imaging provides. And it's sort of that partnership of we're not expecting it to be perfect, but is it better than we have today? There is no perfect solution, but does it improve our current workflow? And so we'll be very interested of when we go live with patients synopsis of does this help? Is this better than what we have today? And the focus then becomes partnering with Watson Health Imaging is how do we make it better for ourselves? How do we make it better for you? I think we're a large health organization and typically we're not an academic or heavy research institution, but we take care of a lot of patients. And if we can work together, I think we'll find solutions. It's really that triple aim of how to provide better care, at cheaper costs, with a better experience. And that's what we're all after. And what's your version of patient, the current version of patients synopsis, and okay does it work for us? Well, even if it does, how do we make it better? Or if it doesn't, how do we make it work? And I think if we work together, make it work for TriHealth, you can make it work at all your community-based health organizations. >> Yeah. So, John that brings me to, Dr. Huelsman mentioned a couple of things in terms of the outcomes. Lower costs, better patient experience, et cetera. I mean, generally for clients, how do you measure success? And then specifically with regard to TriHealth, what's that like? What's that part of the partnership? >> Yes, specifically with TriHealth, the measure of success will be when Dr. Huelsman is able to call and be a super reference for us, and have these tools working to his satisfaction. And when he's been able to give us great input from the customer side, to help improve the science side of it. So today he's able to launch his epic EMR in context and he has to dig through the data, looking for those valuable nuggets and with using natural language processing, when he has patients synopsis, that will all be done for him. He'll be able to pull up the study, a CT of the head for instance and he'll be able to get those nuggets of information using natural language processing that Watson services and get the valuable insights without spending five or 10 minutes interrogating the EMR. So we look forward to those benefits for him, from the data analytics side, but then we also look forward to in the future, delivering other AI for the imaging side, to help him find the slices of interest and the defects that are in that particular study. So whether that's with our partner AI solutions or as we bring care advisers to market. So we look forward to his input on those also. >> Can you comment on that Dr. Huelsman? I would imagine that you would be really looking forward to that vision that John just laid out, as well as other practitioners in your organization. Maybe you could talk about that, is that sort of within your reach? What can you tell us? >> Well, absolutely. That was sort of the shared vision and relationship that we hope for and sort of have that shared outlook is we have all this data, how do we analyze it to improve, provide better care cheaper? And there's no way to do that without you harnessing technology. And IBM has been on the cutting edge of technology for my lifetime. And so it's very exciting to have a partnership with WHI and IBM. There's a history, there's a depth. And so how do we work together to advance, because we want the same things. What impressed me was sure, radiology and AI has been in the news and been hyped and some think over-hyped, and what have you. Everyone's after that Holy grail. But it's that sense of you have the engineers that you talk to, but there is an understanding that don't design the system for the engineers, design it for the end user. Design it for the radiologist. Talk to the end user, because it can be the greatest tool in the world, but I can tell you as a radiologist, if it interrupts my workflow, if it interrupts my search pattern for looking at images, it doesn't help me and radiologists won't use it. And so just having a great algorithm won't help. It is how do you present it to the end user? How do I access it? How can I easily toggle on and off, or do I have to minimize and maximize, and log into a different system. We talked earlier is one throat to choke, or one vendor to hug, we only want one interface. Radiologists and users just want to look at their... They have the radiology viewer, they have their PACS, we look at it all day and you don't want to minimize that and bring up something else, you want to keep interacting with what you're used to. And the mouse buttons do the same thing, it's a mouse click away. And that's what the people at Watson Health Imaging that we've interacted with, they get it. They understand that's what a radiologist would want. They want to continue interacting with their PACS, not with a third vendor or another program or something else. >> I love that. That ton of outside in thinking, starting with the radiologist, back to the engineer, not the reverse. I think that's something that IBM, and I've been watching IBM for a long time, it's something that IBM has brought to the table with its deep industry expertise. I maybe have some other questions, but John I wanted to give you an opportunity. Is there anything that you would like to ask Dr. Huelsman that maybe I haven't touched on yet? >> Yeah. Being back on your account this year, what do you see as a success? What would you count as a success at the end of 2021, if we can deliver this year for you? >> The success would be say, at the end of the year, we've got the heavy hitters, all stored on the archive. Do we pick up all the little, we've got the low hanging fruit, now can we go after the line placement imaging and the arthroscopy and dioscomy, and all those smaller volume in pickups, that we truly get all of our imaging stored on that archive. And then the even larger piece is then do we start using the data on the archive with some cognitive solution? I would love to successfully implement, whether it's patient synopsis or one of the care advisors, that we start using sort of the analytics, the machine learning, some AI component that we successfully implement and maybe share good ideas with you. And sure we intend to go live with patient synopsis next month. I would love it by the end of the year, if the version that we're using patients synopsis and we find it helpful. And the version we use is better than what we went live with next month, because of feedback that we're able to give you. >> Great we looked forward to working with you on that. I guess, personally, with the pandemic in 2020, what have you become, I guess in 2020 that maybe you weren't a year ago before the pandemic, just out of curiosity? >> I'm not sure if we're anything different. A mantra that we've used in the department of radiology at TriHealth for a decade, "Improved service become more adaptable." And we're a service industry, so of course we want to improve service, but be adaptable, become more adaptable. And COVID certainly emphasize that need to be adaptable, to be flexible and the better tools we have. It was great early in the COVID when we had the shutdowns, we found ourselves, we have way more radiologists than we had studies that needed interpreted. So we were flexible all often and be home more. Well, the referring physicians don't know like, well is Dr. Huelsman working today? We don't expect them to look up our schedules. If I get a page that, Hey, can you take a look at this? It was great that at that time I didn't have a home workstation, but I had iConnect access. Before there was no way for me to access the images without getting on a VPN and logging on, it takes 10, 15 minutes before I'm able. Instead I could answer the phone, and I'm not going to say, "Oh, I'm sorry, I'm not at the hospital day, call this number someone else will help you." I have my iPad, go to ica.trihealth.com logged on, I'm looking at the images two minutes later. And so the ease of use, the flexibility, it helped us become adaptable. And I anticipate with we're upgrading the radiology viewer and the iConnect access next month as well, to try to educate our referring physicians, of sort of the image sharing capabilities within that next version of our viewer. Because telehealth has become like everywhere else. It's become much more important at TriHealth during this pandemic. And I think it will be a very big satisfier for both referring physicians and patients, that those image sharing capabilities, to be able to look at the same image, see the annotation that either the radiologist or the referring physician, oncologist, whoever is wanting to share images with the patient and the patient's family, to have multiple parties on at the same time. It will be very good. >> With the new tools that you have for working from home with your full workstation, are you as efficient reading at home? >> Yes. >> And having full access to the PACS as in-house? >> Absolutely. >> That's great to hear. Have you been able to take advantage of using any of the collaboration tools within iConnect, to collaborate with a referring physician, where he can see your pointer and you can see his, or is that something we need to get working? >> Hopefully if you ask me that a year from now, the answer will be yes. >> So does that exit a radiologist? Does that help a radiologist communicate with a referring physician? Or do you feel that that's going to be a- >> Absolutely. We still have our old school physicians that we love who come to the reading room, who come to the department of radiology and go over studies together. But it's dwindling, it's becoming fewer and fewer as certain individuals retire. And it's just different. But the more direct interaction we can have with referring physicians, the better information they can give us. And the more we're interacting directly, the better we are. And so I get it, they're busy, they don't want to, they may not be at the hospital. They're seeing patients at an outpatient clinic and a radiologist isn't even there, that's where that technology piece. This is how we live. We're an instantaneous society. We live through our phone and so great it's like a FaceTime capability. If you want to maintain those personal relationships, we're learning we can't rely on the orthopedist or whomever, whatever referring physician to stop by our reading room, our department. We need to make ourselves available to them and make it convenient. >> That market that you working in Cincinnati, we have a luxury of having quite a few customers with our iConnect solutions. There's been some talk between the multiple parties, of potentially being able to look across the other sites and using that common tool, but being able to query the other archives. Is that something that you'd in favor of supporting and think would add value so that the clinicians can see the longitudinal record? >> Yes And we already have that ability of we can view care everywhere in our EMR. So we don't have the images right away, but we can see other reports. Again, it's not convenient. It's not a click away, but it's two, three, four clicks away. But if I see, if it's one of my search patterns of I just worked the overnight shift last week and then you get something through the ER and there's no comparisons, and it's an abnormal chest CT. Well, I look in Care Everywhere. Oh, they had a chest CT at a different place in the city a year ago, and I can see the report. And so then at that time I can request, and it can take an hour or so, but look back and the images will be accessible to me. But so how do we improve on that? Is to make the images, that I don't have to wait an hour for the images. If we have image sharing among your organizations that can be much quicker, would be a big win. >> As you read in your new environment, do you swivel your chair and still read out of any other specialty systems, for any types of studies today? >> No, and that was a huge win. We used to have a separate viewing system for mammography and we were caught like there were dedicated viewing stations. And so even though we're a system, the radiologist working at this hospital, had to read the mammograms taken at that hospital. And one at the other hospital could only read the ones taken at that hospital. And you couldn't share the workload if it was heavy at one site and light at the other. Well, now it's all viewed through the radiology viewer if you merge PACS, in not just general radiology, but impressed. It has been so much better world that the workflow is so much better, that we can share the work list and be much more efficient. >> Do you feel that in your, your new world, that you're able to have less cherry picking between the group, I guess? Do you feel like there's less infighting or that the exams are being split up evenly through the work list? Or are you guys using some sort of assignment? >> No. And I'm curious with our next version of PACS, the next version of merge packs of 008. I forget which particular >> John: 008. >> It's 008, yeah. I know there's the feature of a smart work list to distribute the exams. Currently, we just have one. It's better than what we have before. It's one large list. We've subdivided, teased out some things that not all of the radiologist read of like MSK and cardiac and it makes it more convenient. But currently it is the radiologist choose what study they're going to open next. To me how I personally attack the list is I don't look at the list. Some radiologists can spend more time choosing what they're going to read next than they do reading. (chuckles) And so if you don't even look, and so the feature I love is just I don't want to take my eyes off my main viewer. And I don't want to swivel my chair. I don't want to turn my head to look at the list, I want everything right in front of me. And so currently the way you can use it is I never look at the list. I just use the keyboard shortcuts of, okay, well I'm done with that study. I mark it, there's one button I click on my mouse that marks it dictated, closes it and brings up the next study on the list. >> Hey guys, I got to jump in. We're running up against the clock, but John if you've got any final thoughts or Dr. Huelsman, please. >> Sure. Dr. Huelsman, I guess any homework for me? What are the top two or three things I can help you with in 2021 to be successful? >> Keep us informed of what you're working on, of what's available now. What's coming next, and how soon is it available? And you let us see those things? And we'll give you a feedback of hey, this is great. And we'll try to identify things, if you haven't thought of them, hey, this would be very helpful. >> Gents, great conversation. Gosh we could go on for another 45 minutes. And John you really have a great knowledge of the industry. And Dr. Huelsman, thanks so much for coming on. Appreciate it. >> Thank you. >> You're welcome >> And thanks for spending some time with us. 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